Provider Demographics
NPI:1629118534
Name:ANDERSON, SOLANGE (CCC-A)
Entity Type:Individual
Prefix:MRS
First Name:SOLANGE
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 HACIENDA CIR
Mailing Address - Street 2:
Mailing Address - City:PLANTSVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06479-1912
Mailing Address - Country:US
Mailing Address - Phone:860-426-0257
Mailing Address - Fax:
Practice Address - Street 1:160 WEST ST BLDG 1
Practice Address - Street 2:SUITE B
Practice Address - City:CROMWELL
Practice Address - State:CT
Practice Address - Zip Code:06416-2441
Practice Address - Country:US
Practice Address - Phone:860-632-5003
Practice Address - Fax:860-632-5532
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000452231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist